Results Generated From:
EMBASE <1980 to 2010 Week 32>
EMBASE (updates since 2010-08-05)
<1>
Accession Number
2010403226
Authors
Brophy J.M.
Institution
(Brophy) McGill University, Montreal, QC, Canada
Title
Ticagrelor was more effective than clopidogrel in acute coronary syndromes
with planned invasive treatment: Commentary.
Source
Annals of Internal Medicine. 152 (10) (pp JC5-4), 2010. Date of
Publication: 18 May 2010.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
<2>
Accession Number
20650361
Authors
Kramer D.G. Trikalinos T.A. Kent D.M. Antonopoulos G.V. Konstam M.A.
Udelson J.E.
Institution
(Kramer) Division of Cardiology and the CardioVascular Center, Tufts
Medical Center, Boston, Massachusetts 02111, USA.
Title
Quantitative evaluation of drug or device effects on ventricular
remodeling as predictors of therapeutic effects on mortality in patients
with heart failure and reduced ejection fraction: a meta-analytic
approach.
Source
Journal of the American College of Cardiology. 56 (5) (pp 392-406), 2010.
Date of Publication: 27 Jul 2010.
Abstract
OBJECTIVES: The purpose of this study was to quantitatively assess the
relationship between therapy-induced changes in left ventricular (LV)
remodeling and longer-term outcomes in patients with left ventricular
dysfunction (LVD). BACKGROUND: Whether therapy-induced changes in left
ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and
end-systolic volume (ESV) are predictors of mortality in patients with LVD
is not established. METHODS: Searches for randomized controlled trials
(RCTs) were conducted to identify drug or device therapies for which an
effect on mortality in patients with LVD was studied in at least 1 RCT of
> or = 500 patients (mortality trials). Then, all RCTs involving those
therapies were identified in patients with LVD that described changes in
LVEF and/or volumes over time (remodeling trials). We examined whether the
magnitude of remodeling effects is associated with the odds ratios for
death across all therapies or associated with whether the odds ratio for
mortality was favorable, neutral, or adverse (i.e., statistically
significantly decreased, nonsignificant, or statistically significantly
increased odds for mortality, respectively). RESULTS: Included were 30
mortality trials of 25 drug/device therapies (n = 69,766 patients; median
follow-up 17 months) and 88 remodeling trials of the same therapies (n =
19,921 patients; median follow-up 6 months). The odds ratio for death in
the mortality trials was correlated with drug/device effects on LVEF (r =
-0.51, p < 0.001), EDV (r = 0.44, p = 0.002), and ESV (r = 0.48, p =
0.002). In (ordinal) logistic regressions, the odds for neutral or
favorable effects in the mortality RCTs increased with mean increases in
LVEF and with mean decreases in EDV and ESV in the remodeling trials.
CONCLUSIONS: In patients with LVD, short-term trial-level therapeutic
effects of a drug or device on LV remodeling are associated with
longer-term trial-level effects on mortality. Copyright 2010 American
College of Cardiology Foundation. Published by Elsevier Inc. All rights
reserved.
<3>
Accession Number
20650362
Authors
Brodie B.R. Gersh B.J. Stuckey T. Witzenbichler B. Guagliumi G. Peruga
J.Z. Dudek D. Grines C.L. Cox D. Parise H. Prasad A. Lansky A.J. Mehran R.
Stone G.W.
Institution
(Brodie) LeBauer Cardiovascular Research Foundation, Greensboro, North
Carolina,
Title
When is door-to-balloon time critical? Analysis from the HORIZONS-AMI
(Harmonizing Outcomes with Revascularization and Stents in Acute
Myocardial Infarction) and CADILLAC (Controlled Abciximab and Device
Investigation to Lower Late Angioplasty Complications) trials.
Source
Journal of the American College of Cardiology. 56 (5) (pp 407-413), 2010.
Date of Publication: 27 Jul 2010.
Abstract
OBJECTIVES: Our objective was to evaluate the impact of door-to-balloon
time (DBT) on mortality depending on clinical risk and time to
presentation. BACKGROUND: DBT affects the mortality rate in ST-segment
elevation myocardial infarction treated with primary percutaneous coronary
intervention, but the impact may vary across subgroups. METHODS: The
CADILLAC (Controlled Abciximab and Device Investigation to Lower Late
Angioplasty Complications) and HORIZONS-AMI (Harmonizing Outcomes with
Revascularization and Stents in Acute Myocardial Infarction) trials
evaluated stent and antithrombotic therapy in patients undergoing primary
percutaneous coronary intervention. We studied the impact of DBT on
mortality in 4,548 patients based on time to presentation and clinical
risk. RESULTS: The 1-year mortality rate was lower in patients with short
versus long DBT (< or = 90 min vs. >90 min, 3.1% vs. 4.3%, p = 0.045).
Short DBTs were associated with a lower mortality rate in patients with
early presentation (< or = 90 min: 1.9% vs. 3.8%, p = 0.029) but not those
with later presentation (>90 min: 4.0% vs. 4.6%, p = 0.47). Short DBTs
showed similar trends for a lower mortality rate in high-risk (5.7% vs.
7.4%, p = 0.12) and low-risk (1.1% vs. 1.6%, p = 0.25) patients. Short
DBTs had similar relative risk reductions in patients with early
presentation in high-risk (3.7% vs. 7.0%, p = 0.08) and low-risk (0.8% vs.
1.5%, p = 0.32) patients, although the absolute benefit was greatest in
high-risk patients. CONCLUSIONS: Short DBTs (< or = 90 min) are associated
with a lower mortality rate in patients with early presentation but have
less impact on the mortality rate in patients presenting later. The
absolute mortality rate reduction with short DBT is greatest in high-risk
patients presenting early. These data may be helpful in designing triage
strategies for reperfusion therapy in patients presenting to
non-percutaneous coronary intervention hospitals. Copyright 2010 American
College of Cardiology Foundation. Published by Elsevier Inc. All rights
reserved.
<4>
Accession Number
2010336032
Authors
Pokushalov E. Romanov A. Chernyavsky A. Larionov P. Terekhov I. Artyomenko
S. Poveshenko O. Kliver E. Shirokova N. Karaskov A. Dib N.
Institution
(Pokushalov, Romanov, Chernyavsky, Larionov, Terekhov, Artyomenko,
Poveshenko, Kliver, Shirokova, Karaskov) State Research Institute of
Circulation Pathology, Rechkunovskaya 15, 630055 Novosibirsk 55, Russian
Federation
(Dib) University of California-San Diego, San Diego, CA, United States
Title
Efficiency of intramyocardial injections of autologous bone marrow
mononuclear cells in patients with ischemic heart failure: A randomized
study.
Source
Journal of Cardiovascular Translational Research. 3 (2) (pp 160-168),
2010. Date of Publication: April 2010.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Intramyocardial transplantation of autologous bone marrow mononuclear
cells (BMMC) is believed to be a promising method for the treatment of
patients with chronic ischemic heart disease. The aim of this study was to
evaluate long-term results of intramyocardial bone marrow cell
transplantation in patients with severe ischemic heart failure. One
hundred nine patients with chronic myocardial infarction and end-stage
chronic heart failure were randomized into two groups: 55 patients
received intramyocardial BMMC injection and 54 received optimal medical
therapy. The NOGA system (Biosense-Webster) was used to administer
41+/-16x106 BMMC into the border zone of myocardial infarction. None of
the patients developed periprocedural complications following BMMC
injections. The injections led to improvement of CCS class (3.1+/-0.4 to
1.6+/-0.6 after 6 months and 1.6+/-0.4 after 12 months; p=0.001) and NYHA
functional class (3.3+/-0.2 to 2.3+/-0.2 after 6 months and 2.5+/-0.1
after 12 months; p=0.006). Left ventricular ejection fraction increased
significantly in the BMMC group (27.8+/-3.4% vs 32.3+/-4.1%; p=0.04) while
it tended to decrease in the control group (26.8+/-3.8% to 25.2+/- 4.1%;
p=0.61). Summed rest score improved in the BMMC group after 12 months
(30.2+/-5.6 to 27.8+/-5.1; p=0.032). The improvement of stress score was
more noticeable (34.5+/-5.4 to 28.1+/-5.2; p=0.016). Neither stress nor
rest score changed in patients numbers on medical therapy. In BMMC group 6
(10.9%) patients died at 12-month follow-up compared with 21 (38.9%) in
control group (log-rank tes , p=0.0007). Intramyocardial bone marrow cell
transplantation to patients with ischemic heart failure is safe and
improved survival, clinical symptoms, and has beneficial effect on LV
function. Springer Science + Business Media, LLC 2009.
<5>
Accession Number
70227951
Authors
Hirschhorn A. Mungovan S. Richards D. Morris N. Adams L.
Institution
(Hirschhorn, Mungovan) Westmead Private Physiotherapy Services, Sydney,
Australia
(Richards) Westmead Private Cardiology, Sydney, Australia
(Hirschhorn, Morris, Adams) School of Physiotherapy and Exercise Science,
Griffith University, Gold Coast, Australia
Source
Heart Lung and Circulation. Conference: New Zealand Annual Scientific
Meeting of the Cardiac Society of Australia and New Zealand Adelaide, SA
Australia. Conference Start: 20100805 Conference End: 20100808.
Conference Publication: (var.pagings). 19 (pp S5), 2010. Date of
Publication: 2010.
Publisher
Elsevier BV
Abstract
Introduction: Walking is the traditional mode of exercise for Phase I
cardiac rehabilitation (CR). Stationary cycling may provide an alternative
for patients with orthopaedic/neurological problems precluding
weightbearing. We aimed to determine the comparative efficacy of Phase I
CR programs comprising stationary cycling and walking exercise in patients
undergoing coronary artery bypass graft surgery (CABG). Methods:
Sixty-four patients awaiting first-time CABG were randomised to receive
Phase I CR comprising either stationary cycling or corridor walking.
Ten-minute exercise training sessions were scheduled twice daily from the
third post-operative day until hospital discharge. Primary outcomes:
6-minute walk distance (6MWD) and 6-minute cycle work (6MCW) were measured
pre-operatively and at hospital discharge. Secondary outcomes included
postoperative length of stay (LOS), compliance with exercise training, and
exercise training intensity (estimated VO<sub>2</sub>), heart rate (HR)
and blood pressure (BP). Results: Cycling (n= 32) and walking (n= 32)
groups werewell matched at baseline forage, 6MWDand 6MCW. At discharge,
there was no difference between cyclists and walkers for 6MWD
(402+/-93mversus417+/-86m, p= 0.803) or 6MCW (15.0+/-6.4 kJ versus 14.0+/-
6.3 kJ, p= 0.798). There was no difference between groups in LOS (median
7, IQR 7-8.5 days versus median 7, IQR 7-8 days, p= 0.335). Both groups
exhibited excellent compliance, with 26/32 cyclists and 28/32 walkers
completing >50% of scheduled exercise sessions. Mean estimated
VO<sub>2</sub> for exercise training sessions was higher for cyclists than
walkers (p <0.001) but HR and BP responses to exercise training were
similar. Conclusion: Stationary cycling provides a well-tolerated and
clinically effective alternative to walking exercise in Phase I CR after
CABG.
<6>
Accession Number
70228228
Authors
Chan W. Andrianopoulos N. Clark D. Ajani A. Brennan A. Newcomb A. Naidu P.
Smith J. Butler M. Freeman M. Dart A. Dinh D. Duffy S.
Institution
(Chan, Naidu, Butler, Dart, Duffy) Alfred Hospital, Australia
(Andrianopoulos, Brennan, Dinh) Department of Epidemiology and Preventive
Medicine (DEPM), Monash University, Australia
(Clark, Freeman) Austin Hospital, Australia
(Ajani) Royal Melbourne Hospital, Australia
(Newcomb) St. Vincent's Hospital, Australia
(Smith) Southern Health, Australia
Source
Heart Lung and Circulation. Conference: New Zealand Annual Scientific
Meeting of the Cardiac Society of Australia and New Zealand Adelaide, SA
Australia. Conference Start: 20100805 Conference End: 20100808.
Conference Publication: (var.pagings). 19 (pp S125), 2010. Date of
Publication: 2010.
Publisher
Elsevier BV
Abstract
Background: Sub-group analyses of several randomised-controlled trials of
percutaneous coronary intervention (PCI) versus coronary artery bypass
grafting (CABG) suggest that diabetics with multivessel coronary artery
disease (CAD) have improved event-free survival with CABG. Method: We
compared clinical characteristics and longterm mortality using National
Death Index data in 3455 patients with diabetes who underwent
revascularization; either PCI (n= 1112; 32%) or CABG (n= 2343; 68%) in two
large, parallel, multi-centre registries from April 2004 to October 2008.
Cardiogenic shock, acute myocardial infarction (MI) <24h, previous CABG,
associated valve surgery or prior PCI were exclusions. Predictors of
long-term mortality were determined using multivariate Cox-proportional
hazard modelling. Results: Both PCI and CABG groups had similar age,
ejection fraction and BMI. Patients undergoing CABG were more likely to be
males, dyslipidaemic, hypertensive, have cerebrovascular and peripheral
arterial disease, prior MI, heart failure, higher intra-aortic balloon
pump use, and multivessel CAD (all p < 0.0001). Bycontrast, more PCI
patients had recent MI (1-7 days prior), creatinine >200 mumol/L, and were
current smokers (all p <= 0.02). Over 2.2 years of follow-up, mortality
was similar between the CABG and PCI cohorts (6.0% vs. 5.4%, p = 0.47).
Significant multivariate predictors of mortality included age (HR 1.05 per
year; 95% CI 1.03-1.06, p < 0.0001), creatinine (4.3; 2.9-6.4, p< 0.0001),
IABP use (3.0; 1.7-5.3, p < 0.0001) and prior MI (1.5; 1.1-2.1, p = 0.01),
but not the mode of revascularisation (0.99; 0.7-1.5, p = 0.94).
Conclusion: In this multi-centre, real world registry of patients with
diabetes requiring revascularization, CABG and PCI provide comparable
long-term mortality benefit.
<7>
Accession Number
70228482
Authors
Kiat A. Dignan R. Gebski V. Keech A.
Institution
(Kiat) University of New South Wales, Randwick, Australia
(Dignan) Liverpool Hospital, Sydney South West AHS, Sydney, Australia
(Gebski, Keech) NHMRC Clinical Trials Centre, University of Sydney, Syney,
Australia
(Keech) Royal Prince Alfred Hospital, Camperdown, Australia
Source
Heart Lung and Circulation. Conference: New Zealand Annual Scientific
Meeting of the Cardiac Society of Australia and New Zealand Adelaide, SA
Australia. Conference Start: 20100805 Conference End: 20100808.
Conference Publication: (var.pagings). 19 (pp S233), 2010. Date of
Publication: 2010.
Publisher
Elsevier BV
Abstract
Objectives: The aimofthis study was to examine a novel technique of
postoperative sternotomy pain control following coronary artery bypass
graft surgery (CAGs) and its impact on recovery time and chronic pain from
surgery (CPS). This was a retrospective review of a quality assurance
project and an observational study about chronic pain in the same
population. Methods: A total of 13 patients who underwent surgery at
Liverpool Hospital between November 2007 and March 2008 were treated with
a PainBuster (I-Flow, Inc.) device for continuous infusion of ropivacaine
solution for 4 days through long catheters inserted bilaterally to the
sternal wound. Postoperative outcomes of low risk PainBuster patients were
retrospectively compared to a historical control (n= 172). Chronic pain
outcomes were investigated by follow-up of all PainBuster patients and a
propensity matched cohort (n= 13) via questionnaire. The proportion of
patients with CPS 2 years after surgery was compared. Results: The
proportion of patients with an ICU stay<48 h was 5/8 (63%) in the
PainBuster group and 77/172 (45%; p = 0.33) in the historical control
group. The mean time to discharge from ICU was significantly less in the
low risk PainBuster group (38+/-27 versus 65+/- 53h; p= 0.01). Chest wound
chronic pain appeared slightly less frequent amongst Pain Buster
patients(1/7 patientsor14%) than amongst propensity matched control
patients (5/11 patients or 45%, p= 0.23). Conclusions: A non-significantly
greater proportion of patients receiving the PainBuster local anaesthetic
intervention were discharged from ICU in less than 48h. There was a
shorter the time to ICU discharge and proportion of patients with chronic
pain in patients treated with local anaesthetic compared to the matched
control groups was non-significantly lower. A large, randomised controlled
trial is underway to determine the impact of this technique on these
important outcomes more reliably.
<8>
Accession Number
70228488
Authors
Edelman J. Yan T. Padang R. Bannon P. Vallely M.
Institution
(Edelman, Yan, Bannon, Vallely) Baird Institute, Royal Prince Alfred
Hospital, University of Sydney, Australia
(Padang) Department of Cardiology, Royal Prince Alfred Hospital, Australia
Source
Heart Lung and Circulation. Conference: New Zealand Annual Scientific
Meeting of the Cardiac Society of Australia and New Zealand Adelaide, SA
Australia. Conference Start: 20100805 Conference End: 20100808.
Conference Publication: (var.pagings). 19 (pp S235), 2010. Date of
Publication: 2010.
Publisher
Elsevier BV
Abstract
The SYNTAX trial showed that coronary artery bypass grafting remains the
standard of treatment for left main and three-vessel coronary artery
disease, with lower rates of major cardiac and cerebrovascular outcome and
revascularisation at 12 months when compared to percutaneous coronary
intervention. Surgery did, however, have a higher rate of stroke in the
post-operative period. CABG most commonly involves cannulation of the
aorta and right atrium, aortic cross clamp, and anastomosis of proximal
ends of grafts to the aorta. A number of trials have suggested that the
rate of stroke in off-pump coronary artery bypass surgery is lower than
when cardiopulmonary bypass is used. Frequently in OPCAB a side-biting
clamp is used to anastomose the proximal ends of bypass grafts.Some trials
have suggested that the rate of stroke in CABG or OPCAB is directly
related to the aortic manipulation intra-operatively. We performed a
meta-analysis of trials comparing coronary artery bypass grafting with and
without any form of aortic manipulation (the 'no-touch' technique). 10054
patients who under went CABG with a orticmanipulation were compared with
4528 undergoing without any manipulation. The meta-analysis showed a
significant decrease in rate of stroke when manipulation of the aorta was
avoided (2.26% versus 0.88%; p< 0.01). This meta-analysis suggests that
OPCAB without aortic manipulation may improve rates of stroke after
surgical revascularisation.
<9>
Accession Number
70228490
Authors
Padang R. Yan T. Pooh C. Black D. Wilson M. Bannon P. Vallely M.
Institution
(Padang, Yan, Pooh, Black, Wilson, Bannon, Vallely) Baird Institute for
Applied Heart, Lung Surgical Research, Australia
(Yan, Wilson, Bannon, Vallely) University of Sydney, Department of
Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
(Padang) University of Sydney, Department of Cardiology, Royal Prince
Alfred Hospital, Sydney, Australia
(Black) Faculty of Health Sciences, Sydney, NSW, Australia
Source
Heart Lung and Circulation. Conference: New Zealand Annual Scientific
Meeting of the Cardiac Society of Australia and New Zealand Adelaide, SA
Australia. Conference Start: 20100805 Conference End: 20100808.
Conference Publication: (var.pagings). 19 (pp S236), 2010. Date of
Publication: 2010.
Publisher
Elsevier BV
Abstract
Purpose: We performed the present systematic review and meta-analysis of
the randomized and nonrandomized comparative studies in an attempt to
compare the safety and efficacy of drug-eluting stents (DES) with coronary
artery bypass grafting (CABG) for patients with coronary artery disease.
Methods: Electronic searches identified 25 eligible comparative studies
(one randomized and 24 nonrandomized) for inclusion. Two reviewers
independently appraised each study. Meta-analysis was performed by
combining the results of reported incidence of morbidity, mortality and
repeat revascularization. The relative risk (RR) was used as a summary
statistic. Results: In these 25 studies, 34,278 patients were compared, of
whom 18,538 patients received DES and 15,740 patients underwent CABG. The
accumulative incidence of periprocedural myocardial infarction (1.4% vs.
2.0%, p = 0.60), all-cause mortality at 12 months (4.5% vs. 4.0%, p =
0.92) and 24 months (6.2% vs. 8.4%, p= 0.27) were similar between DES and
CABG groups. DES was associated with lower rates of stroke (0.4% vs. 1.7%,
p< 0.001), allcause mortality at 30 days (0.9% vs. 2.3%, p< 0.001) and
30-day MACCE (3.6% vs. 5.5%, p<0.04). However, CABG group had lower
incidence of postprocedural myocardial infarction (5.5% vs. 4.7%, p=
0.03), 12-month MACCE (16.7% vs. 10.5%, p < 0.001) and repeat
revascularization (22.2% vs. 4.1%, p< 0.001). Subgroup analysis on
patients with multi-vessel coronary artery disease showed similar results.
Conclusion: Periprocedural risks of DES are acceptable, but the
non-inferiority of DES to CABG has not been supported by the current
evidence.
<10>
Accession Number
70228496
Authors
Edelman J. Yan T. Padang R. Bannon P. Vallely M.
Institution
(Edelman, Yan, Bannon, Vallely) Baird Institute, Royal Prince Alfred
Hospital, University of Sydney, Australia
(Padang) Department of Cardiology, Royal Prince Alfred Hospital, Australia
Source
Heart Lung and Circulation. Conference: New Zealand Annual Scientific
Meeting of the Cardiac Society of Australia and New Zealand Adelaide, SA
Australia. Conference Start: 20100805 Conference End: 20100808.
Conference Publication: (var.pagings). 19 (pp S238), 2010. Date of
Publication: 2010.
Publisher
Elsevier BV
Abstract
Background: We performed a meta-analysis of all studies comparing off-pump
coronary artery bypass (OPCAB) and percutaneous coronary intervention
(PCI) for patients with coronary artery disease. Methods: We
comprehensively retrieved randomized and non-randomized studies comparing
OPCAB and PCI. Data was extracted from each study and a meta-analysis
performed for the following outcomes: cerebrovascular event,
peri-procedural myocardial infarction, postprocedural myocardial
infarction, peri-operative cardiac death, post-operative cardiac death,
all-cause mortality at 30 days, all-cause mortality at 12 months, 12-month
major cardiac and cerebrovascular event (MACCE) and repeat
revascularization. Results: Fourteen studies were identified. Duplicates
were removed and 10 studies were included in the metaanalysis. In these 10
studies, 4821 patients were compared, of whom 3450 patients underwent PCI
and 1371 patients underwent OPCAB. The rates of stroke (relative risk
(RR)=0.85, 95% confidence interval (CI) =0.28-2.63), and
pre-/post-procedural myocardial infarction, cardiac mortality and
all-cause mortality were similar. The 12 month rate of MACCE (RR=1.56; 95%
CI=1.29-1.90) and need for repeat revascularization (RR =2.98; CI
=2.24-3.97) was significantly lower in the OPCAB group when compared with
PCI group. Conclusions: A major criticism of coronary artery bypass
grafting (CABG) in the SYNTAX trial was the increased rate of stroke.
OPCAB surgery may offer a similar rate of stroke compared with PCI
together with lower risk of MACCE and requirement for repeat
revascularisation.
<11>
Accession Number
70228504
Authors
Murphy B. Higgins R. Worcester M. Elliott P. Navaratnam H. Mitchell F. Le
Grande M. Goble A.
Institution
(Murphy, Higgins, Worcester, Elliott, Navaratnam, Mitchell, Le Grande,
Goble) Heart Research Centre, Australia
Source
Heart Lung and Circulation. Conference: New Zealand Annual Scientific
Meeting of the Cardiac Society of Australia and New Zealand Adelaide, SA
Australia. Conference Start: 20100805 Conference End: 20100808.
Conference Publication: (var.pagings). 19 (pp S242), 2010. Date of
Publication: 2010.
Publisher
Elsevier BV
Abstract
Background: Cognitive behavioural therapy (CBT) involves techniques
designed to assist people with health behaviour change and emotional
wellbeing. The Heart Research Centre developed and delivered an 8-week
group secondary prevention program -'Beating HeartProblems' - for cardiac
patients based upon CBT principles. Methods: A consecutive series of 275
patients admitted to two hospitals after acute myocardial infarction (32%)
or for coronary artery bypass graft surgery (40%) or percutaneous coronary
intervention (28%) were recruited into a randomised controlled trial.
Patients were aged 32-75 years (M= 59.0; SD= 9.1). Most (86%) were male.
Clinic assessments were conducted at baseline and 4 and 12 months with
data available on 213 participants (treatment=119, control=113). Results:
At four months, treatment group patients showed a significantly greater
increase in functional capacity as assessed by the 6-min walk test
(baseline M(SD)=511 (80)m; 4 month M(SD)=547(74)m) than the control group
(baseline M(SD)=517 (90) m; 4 month M(SD)=539(93) m), F(1,183)= 4.33,
p=.039. The treatment group also showed significant improvement in their
self-reported dietary fat intake (baseline M(SD) =16.3(7.0); 4 month M(SD)
=15.2(6.6)) while the control group worsened (baseline M(SD)=16.8 (8.2); 4
month M(SD)=17.5(6.9)), (F(1,183)=4.33, p=.039). Two year risk of a
recurrent cardiac event showed nonsignificant trends favouring the
treatment group. Conclusions: There is potential for incorporating this
CBT program into the existing cardiac rehabilitation service delivery
model. Other options for delivery of the 'Beating Heart Problems' program
will be discussed.
<12>
Accession Number
70221188
Authors
Hanslik A. Kitzmller E. MlekuschW. Salzer-Muhar U. Michel-Behnke I. Male
C.
Institution
(Hanslik, Kitzmller, Salzer-Muhar, Michel-Behnke, Male) Division of
Pediatric Cardiology, Department of Pediatrics, Medical University of
Vienna, Austria
(MlekuschW.) Department of Internal Medicine, Medical University of
Vienna, Austria
Source
Cardiology in the Young. Conference: 44th Annual Meeting of the
Association for European Paediatric Cardiology, AEPC with Joint Sessions
with the Japanese Society of Pediatric Cardiology and Cardiac Surgery
Innsbruck Austria. Conference Start: 20100526 Conference End: 20100529.
Conference Publication: (var.pagings). 20 (pp S39), 2010. Date of
Publication: April 2010.
Publisher
Cambridge University Press
Abstract
Introduction: Thrombotic complications are serious complications of
cardiac catheterization (CC) in children. Clinical signs of arterial and
venous thrombosis are unreliable in children but few studies have used
objective ultrasound testing. Moreover, only few studies have assessed
unfractionated heparin (UFH) protocols for prophylaxis of CC-related
thrombosis. Therefore, the optimal UFH dose for CC in children is not
known. Objective: To (i) describe the incidence of thrombosis during CC in
children using ultrasound assessment, and (ii) compare a highdose versus a
low-dose UFH protocol for thromboprophylaxis. Methods: Randomized
controlled trial comparing high-dose UFH (100 u/kg bolus, followed by 20
u/kg/h continuous infusion) versus low-dose UFH (50 u/kg bolus) during
elective CC in children with congenital heart disease at a tertiary care
pediatric cardiology centre. Outcome assessment was by i) documentation of
clinical signs of thrombosis and ii) vascular ultrasound performed before
and within 48 hours after CC. Patients without consent for randomization
received standard of care heparin, but received the same outcome
assessment and were followed in a cohort study (cohort study). Results:
201 children were included in the study (median age 5.6 years, 23%
infants, 39% females). Ninety-eight patients (49%) underwent
interventional CC. Overall, 9 (5%) patients developed thrombosis (6 (3%)
arterial, 3 (2%) deep venous); 5 patients had other vascular complications
(3 arteriovenous fistulae, 2 pseudoaneurysm). Arterial thrombosis occurred
in infants only, whereas deep venous thrombosis was only seen in older
children. Minor bleeding at puncture site occurred in 13 (7%) patients,
and only 1 patient needed red cell transfusion. Of 201 patients, 120
children were randomized to one of the two heparinisation protocols (58
low-dose UFH, 62 high-dose UFH). There was no significant difference in
incidence of vascular thrombosis or minor bleeding between the two groups.
Conclusions: Incidence of thrombosis during CC in children was 5% using
ultrasound screening. Infants were at particular risk for arterial
thrombosis. The incidence of bleeding was 7% which was mostly minor.
High-dose UFH was not superior to low-dose UFH for prophylaxis of
cardiac-catheterization associated vascular thrombosis.
<13>
Accession Number
70221339
Authors
Kitzmller E. Hanslik A. Karapetian H. Salzer-Muhar U. Michel-Behnke I.
Male C.
Institution
(Kitzmller, Hanslik, Karapetian, Salzer-Muhar, Michel-Behnke, Male)
Division of Pediatric Cardiology, Department of Pediatrics, Medical
University of Vienna, Austria
Source
Cardiology in the Young. Conference: 44th Annual Meeting of the
Association for European Paediatric Cardiology, AEPC with Joint Sessions
with the Japanese Society of Pediatric Cardiology and Cardiac Surgery
Innsbruck Austria. Conference Start: 20100526 Conference End: 20100529.
Conference Publication: (var.pagings). 20 (pp S95), 2010. Date of
Publication: April 2010.
Publisher
Cambridge University Press
Abstract
Introduction: Monitoring unfractionated heparin (UFH) in children is
problematic because of variable dose-response. Objectives: To assess (i)
the relationship between UFH dose and UFH plasma levels as tested by
various assays and (ii) the correlation between these assays. Methods:
Randomized controlled trial comparing two UFH protocols (high dose: 100
u/kg body weight bolus, followed by continuous infusion of 20 u/kg/hour;
low dose: 50 u/kg bolus) for prevention of thrombosis during elective
cardiac catheterization. Children with congenital heart disease at a
tertiary care pediatric cardiology centre. Clinical outcome were vascular
complications associated with cardiac catheterization assessed by vascular
ultrasound. Blood samples were taken before and 30, 60 and 90 minutes
after UFH administration. Assays: anti-Xa (aXa), activated partial
throm-boplastin time (APTT), activated clotting time (ACT), thrombin
genera-tion (TG). Results: Interim laboratory analysis of 65 patients.
Thirty-two patients were in high dose group, 33 patients in low UFH dose.
All four assays showed significant discrimination between UFH dose groups
which was best for aXa, followed by ACT, TG, and APTT. Correlation of aXa
versus ACT and TG was fair but aXa versus APTT was poor. Low dose
heparinization reached therapeutic levels, whereas high dose
heparinization led to supratherapeutic levels of anticoagulation.
Conclusion: In children during elective cardiac catheterization, vascular
compli-cations were less frequent than anticipated. High and moderately
high doses of UFH were well discriminated using aXa, APTT, ACT and TG.
However, correlation between the results of these assays moderate to poor.
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